Software to reduce emergency hospital admissions gets mixed report from family doctors

A software tool meant to help reduce emergency hospital admissions is of limited use and benefit to patients, a new study of family doctors’ views and experiences has revealed. 

The study builds on earlier research by the same team showing that emergency admissions had gone up – not down - when the tool was introduced in Wales (UK), which led to its rollout being halted, though it continues to be used widely in England, Scotland and Northern Ireland. 

Researchers say the new study reinforces the need for more evidence and research on the implementation of the software and its effects.  

The software is a risk prediction tool, which in Wales is called PRISM. It identifies people who are most at risk of needing emergency care, based on past use of healthcare, diagnoses and medications. The thinking is that targeted management of these patients can reduce emergency admissions to hospital, improve patient outcomes and experience, and provide better value for money.  

However, researchers at Swansea University Medical School, who evaluated the use of PRISM in Wales, found that there is little evidence to suggest that it meets these objectives.

Now, to shed more light on how the tool is used in practice, the same team have published a second study, exploring the views and experiences of GPs (geenral practitioners) and practice managers who used PRISM. 

They interviewed 22 GPs (general practitioners) and practice managers in 18 practices in south Wales, between three and six months after they began using PRISM and then again 18 months later.

They found: 

• GPs generally judged it unlikely that PRISM had any effect on emergency admissions, with a widespread feeling that admissions initiated by GPs were already low with little scope for further reductions 
• Respondents reported the decision to use PRISM was based mainly on wanting to secure incentives offered by the Welsh Government under its Quality and Outcome Framework for improving care 
• Use of PRISM was inhibited by it not being integrated with practice systems  
• Most doubted any large-scale impact from PRISM, but cited examples of impact on individual patient care  
• The majority of respondents reported that PRISM had made them more aware of high-risk patients, flagging up some patients who had not previously been considered to be in the high-risk category. 

The researchers’ overall conclusions were that views of PRISM in general practice were mixed, and that policymakers need more information about how these tools are used in practice, and the effects of these tools on decision-making as well as patient outcomes. 

Professor Helen Snooks from the project team at Swansea University Medical School said: 

“Tools like PRISM are used widely by the NHS in primary and community care, with the aim of reducing emergency hospital admissions. However, there is a lack of evidence to support the view that they enable proactive care and improve patient outcomes. 

Our research highlighted very mixed views and experiences among GPs and practice managers about use of PRISM. This was often short-term and driven by external factors rather than embedded in new ways of working. 

Decision-makers need more information about the implementation and effects of such tools in primary and community settings to inform future policy on their use.

Given the current context of rising emergency admissions, and Department of Health incentives in England to use these risk tools in community services, our findings are important and timely.” 

The study was published in the British Journal of General Practice. 

Notes to editors

Swansea University is a world-class, research-led, dual campus university offering a first-class student experience and has one of the best employability rates of graduates in the UK. The University has the highest possible rating for teaching – the Gold rating in the Teaching Excellence Framework (TEF) in 2018 and was commended for its high proportions of students achieving consistently outstanding outcomes.

Swansea climbed 14 places to 31st in the Guardian University Guide 2019, making us Wales’ top ranked university, with one of the best success rates of graduates gaining employment in the UK and the same overall satisfaction level as the Number 1 ranked university.

The 2014 Research Excellence Framework (REF) 2014 results saw Swansea make the ‘biggest leap among research-intensive institutions’ in the UK (Times Higher Education, December 2014) and achieved its ambition to be a top 30 research University, soaring up the league table to 26th in the UK.

The University is in the top 300 best universities in the world, ranked in the 251-300 group in The Times Higher Education World University rankings 2018.  Swansea University now has 23 main partners, awarding joint degrees and post-graduate qualifications.

The University was established in 1920 and was the first campus university in the UK. It currently offers around 350 undergraduate courses and 350 postgraduate courses to circa 20,000 undergraduate and postgraduate students.  The University has ambitious expansion plans as it moves towards its centenary in 2020 and aims to continue to extend its global reach and realise its domestic and international potential.

Swansea University is a registered charity. No.1138342. Visit www.swansea.ac.uk

For more information:

Kevin Sullivan, senior press officer, Swansea University k.g.sullivan@swansea.ac.uk

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